The Pharmacy Read List: May 25th Edition

The Read List is a biweekly update on pharmaceutical literature. Every two weeks we handpick one of the most relevant and interesting pharmacy-related publications and summarize it for your convenience. At the end of every month, a quiz on that month’s content will be released. Simply take the quiz and answer correctly to be automatically entered into a draw for a gift card prize.

This week we have an summary of a study that links initiation of atypical antipsychotics with an increased risk of developing type 2 diabetes. Have a read below.

This week is the second and final edition of the month which means a new quiz! Correctly answer the questions and you’ll be entered into a draw to win a $10 Starbucks gift certificate!

Due to increased prescribing of atypical antipsychotics (AAP) for children and adolescents, and the safety concern of an increased risk of chronic conditions such as obesity and type II diabetes mellitus (T2DM) with AAP use, Sohn et. al. conducted a retrospective cohort study to determine the risk of new onset T2DM in children and adolescents initiating AAP. In order to determine this risk, the authors compared an AAP user group to a control group that had no exposure to AAP. Patients were considered to be an AAP user if they received at least one prescription of aripiprazole, olanzapine, paliperidone, quetiapine, risperidone, or ziprasidone, preceded by a minimum of 6 months of continuous enrolment in a particular US health insurance plan, no previous exposure to both typical and atypical antipsychotics, and no history of type1 or type 2 diabetes mellitus. Information—such as enrolment files, medical and pharmacy claims—was collected from children who were aged 4 and 18 from January 1, 2007 to December 31, 2009 and enrolled as dependents in the aforementioned health insurance plan. Documentation of medical/pharmacy care related to T2DM was identified as new onset of T2DM and came in the form of (1) a hospital discharge with a T2DM diagnosis and/or (2) two or greater diabetes-related medical/pharmacy claims. To compare the risk of T2DM between the AAP user and non-user groups, propensity score matching (PSM) statistical methodology was utilized to match baseline characteristics of AAP new users to non-users in order to account for covariates and minimize bias due to confounding factors. Through this sample selection methodology, the study identified 6,236 AAP new users and 22,080 non-users after matching—every AAP new user was matched with up to four non-users. The authors estimated and compared the rate of T2DM development using the Kaplan-Meier estimator and Cox proportional hazard regression, respectively. From this, a hazard ratio with a 95% confidence interval was offered. Sohn et al. identified that children and adolescents being prescribed AAP have a two times higher risk of developing T2DM within 6 months of initiating an AAP compared to non users (HR 2.18, 95% CI 1.45-3.29). This study suggests that health care professionals should practice caution when considering initiation of AAP, and weigh the benefits against the risks given the lack of evidence in the long-term efficaciousness of AAP in children and adolescents.